Guide to Health Screening Identifying People at Risk​

Dr Ng Lee Beng, Consultant, Dept of Family Medicine & Continuing Care, described some of the health screening tests that are good to have. Screening leads to early diagnosis and treatment, but there’s no need to go through a battery of tests.

Private operators which offer
health screening, like Parkway
Shenton, Thomson Wellth Clinic
and Raffles Hospital, also report a
healthy demand, thanks in part to
company medical benefits.

Health screening not only helps
detect diseases but also identifies
common risk factors for chronic
diseases, thus enabling people to
take steps to protect themselves.

However, the irony is that most
people are just relieved to get a
clean bill of health and do not act
on information that predicts future
illnesses. This defeats the purpose
of screening as a preventive rather
than a diagnostic tool, said Dr Ng.

NOT ALL TESTS WILL BENEFIT YOU

There is no such thing as an ideal
number of tests to be included in a
health-screening package and no
one needs a comprehensive battery
of tests.

For screening to be useful, the
tests should address common conditions
such as high blood pressure,
high cholesterol, diabetes and
the major organ functions of the
liver, thyroid and kidney, said Dr
Winston Ho, medical director of
Parkway Shenton, a general practice
operator.

These tests have proven to be
valuable as they allow intervention
through early diagnosis, he said.
Dr Emily Pwee, a senior physician
at Raffles Health Screeners,
said screening is advised according
to a person’s medical history,
including his family history, age
and health concerns.

It should be done periodically, as
recommended. If a breast scan last
year turned out normal, it does not
mean the results would be the
same this year, said Dr Derek Koh,
head of the Thomson Wellth Clinic
@ Novena.

And as degenerative and metabolic
diseases such as diabetes
tend to occur after 40, regular
screening after this age is recommended,
said Dr Ho.

Doctors said there are some tests
that are good but not entirely necessary.
For instance, certain cancermarker
tests can result in false positive
readings or false alarms. This
would cause undue anxiety and
stress, and unnecessary spending
on more tests and investigations.

However, a disease can go undetected
due to false negative test results.

When screening test results are
clearly abnormal, there are guidelines
on their significance and the
actions to take, said Dr Ng.

Dr Ho said readings that are out
of the normal range should be
reviewed by the doctor and discussed
with the patient.

He added: “For some readings,
the ‘abnormal’ test may be repeated
at a later date for re-assessment.

“For some others, a more detailed
assessment is necessary.” For example,
a breast lump that is reported
as having a benign appearance on
an ultrasound can be reassessed in
six to 12 months’ time, while another
with an irregular shape may
require further assessment with a
biopsy.

A diagnosis can be missed if
information is lacking or a specific
test is not part of the health-screening
package, he said.

TAKING IT SERIOUSLY

Health screening should involve
medical consultation. Dr Ng said
doctors should let patients know
that silent damage is already occurring,
and empower them with tips
for a sustainable lifestyle change.

For instance, the doctor cannot
simply tell a pre-diabetic patient
“don’t eat this and don’t eat that”
but should, instead, explain why he
has to modify his diet and also
teach him how to do so, she said.

Dr Ng said: “What patients and
health screeners need to take note
of are results that may not ring an
alarm bell now, but may be signs of
a gathering storm.”

A high normal or sporadically
high sugar levels would already indicate
a pre-diabetic state, for
instance. Yet, many patients who
are diagnosed with pre-diabetes
have the mistaken idea that they
are “still safe” and do not need to
make lifestyle changes, said Dr Ng.

They need to know that their pancreas
has already been damaged,
and that they need to act.

There is a high chance of the
organ returning to normal functional
condition if the patient modifies
his diet and starts doing some
exercise to lose the fat that is damaging
his organ, she said.

Doctors said many people tend to
ignore test results which they
deem unimportant or feel will not
have an immediate impact on their
health. “High cholesterol, mildly
elevated blood glucose and mildly
elevated blood pressure are some
examples, as they usually do not
cause any symptoms till late,” said
Dr Ho.

If ignored, these conditions can
give rise to serious events like heart
attack and stroke.

The major benefit of health
screening is to identify people at
risk. By taking small steps such as
losing 5 per cent of their weight,
these people can prevent themselves
from becoming sick, he said.